To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes.

I 116TH CONGRESS 2D SESSION H. R. 6583 To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID–19 emergency, and for other purposes. IN THE HOUSE OF REPRESENTATIVES APRIL 21, 2020 Ms. HOULAHAN (for herself and Mr. LARSON of Connecticut) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consider- ation of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID–19 emergency, and for other pur- poses. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 22:20 Apr 24, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6583.IH H6583 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 6583 IH SECTION 1. ESTABLISHING A RISK CORRIDOR PROGRAM 1 FOR MEDICARE ADVANTAGE PLANS DURING 2 THE COVID–19 EMERGENCY. 3 (a) IN GENERAL.—Section 1853 of the Social Secu- 4 rity Act (42 U.S.C. 1395w–23) is amended by adding at 5 the end the following new subsection: 6 ‘‘(p) RISK CORRIDOR PROGRAM DURING THE 7 COVID–19 EMERGENCY.— 8 ‘‘(1) IN GENERAL.—The Secretary shall estab- 9 lish and administer a program of risk corridors for 10 each plan year, any portion of which occurs during 11 the emergency period defined in section 12 1135(g)(1)(B), under which the Secretary shall 13 make payments to MA organizations offering a 14 Medicare Advantage plan based on the ratio of the 15 allowable costs of the plan to the aggregate pre- 16 miums of the plan. 17 ‘‘(2) PAYMENT METHODOLOGY.—The Secretary 18 shall provide under the program established under 19 paragraph (1) that if the allowable costs for a Medi- 20 care Advantage plan for any plan year are more 21 than 105 percent of the target amount, the Sec- 22 retary shall pay to the plan an amount equal to 75 23 percent of the allowable costs in excess of 105 per- 24 cent of the target amount. 25 ‘‘(3) TIMING.— 26 VerDate Sep 11 2014 22:20 Apr 24, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6583.IH H6583 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 6583 IH ‘‘(A) SUBMISSION OF INFORMATION BY 1 PLANS.—With respect to a plan year for which 2 the program described in paragraph (1) is es- 3 tablished and administered, not later than July 4 1 of the succeeding plan year each MA organi- 5 zation offering a Medicare Advantage plan shall 6 submit to the Secretary such information as the 7 Secretary may require for purposes of carrying 8 out such program. 9 ‘‘(B) PAYMENT.—The Secretary shall pay 10 to an MA organization offering a Medicare Ad- 11 vantage plan eligible to receive a payment under 12 the program with respect to a plan year the 13 amount provided under paragraph (2) for such 14 plan year not later than 60 days after such or- 15 ganization submits information with respect to 16 such plan and plan year under subparagraph 17 (A). 18 ‘‘(4) DEFINITIONS.— 19 ‘‘(A) ALLOWABLE COSTS.—The term ‘al- 20 lowable costs’ means, with respect to an MA or- 21 ganization offering a Medicare Advantage plan 22 for a plan year, an amount equal to the total 23 costs (other than administrative costs) of such 24 plan in providing benefits covered by such plan, 25 VerDate Sep 11 2014 22:20 Apr 24, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6583.IH H6583 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 6583 IH but only to the extent that such costs are in- 1 curred with respect to such benefits for items 2 and services that are benefits under the original 3 medicare fee-for-service program option. 4 ‘‘(B) TARGET AMOUNT.—The term ‘target 5 amount’ means, with respect to an MA organi- 6 zation offering a Medicare Advantage plan for 7 a plan year, the total amount of payments paid 8 to the MA organization for the plan for benefits 9 under the original medicare fee-for-service pro- 10 gram option for the plan year, taking into ac- 11 count amounts paid by the Secretary and en- 12 rollees, based upon the bid amount submitted 13 under section 1854, reduced by the total 14 amount of administrative expenses for the year 15 assumed in such bid. 16 ‘‘(5) FUNDING.—There are appropriated to the 17 Centers for Medicare & Medicaid Services Program 18 Management Account, out of any monies in the 19 Treasury not otherwise obligated, such sums as may 20 be necessary for purposes of carrying out this sub- 21 section.’’. 22 (b) IMPLEMENTATION.—Notwithstanding any other 23 provision of law, the Secretary of Health and Human 24 VerDate Sep 11 2014 22:20 Apr 24, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6583.IH H6583 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 6583 IH Services may implement the amendments made by this 1 section by program instruction or otherwise. 2 Æ VerDate Sep 11 2014 22:20 Apr 24, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H6583.IH H6583 pamtmann on DSKBC07HB2PROD with BILLS